Serum CA-125 and progesterone levels as early indicators of pregnancy viability achieved after art cycles, revisited

Abstract

Serum progesterone levels have been found to be defective before an adverse pregnancy outcome. CA-125 is found in endometrial tissue and glands. Higher levels in conception vs. non conception ART cycles have been found, raising the question about a possible serum marker of endometrial receptivity. The objective of this study is to evaluate the prognostic value of pregnancy outcome of serum CA-125 and progesterone levels in ART cycles. Prospective controlled study. One hundred and one IVF/ICSI-embryo transfer (ET) cycles having positive serum b-hCG levels 12 ± 1 days after fresh embryo transfer (day 0) were prospectively evaluated. During the study period all ART cycles received 400 mg daily of natural progesterone vaginally. Pregnancy outcomes were divided as follows: ongoing pregnancies (group 1): those progressing beyond 12 weeks; adverse pregnancy outcome (group 2) included: preclinical and clinical abortions . CA-125 and progesterone levels were measured on the day of hCG sampling. Wilcoxon´s ranksum test, Fisher's exact test, and Spearman's correlation test were used for statistical analysis. Of the 101 pregnant cycles, 69 (68.3%) resulted in ongoing pregnancies. In group 2, the 32 (31.7%) cases were composed of 17 (53.1%) clinical abortions and 15 (46.9%) preclinical abortions. Age (group 1: 34.1 ± 4.2, group 2: 34.7 ± 4.5 years), basal FSH values, total number and number of metaphase II oocytes retrieved, final estradiol levels, and total number and proportion of good quality embryos replaced were statistically similar in both groups. CA-125 and progesterone levels were statistically comparable across sampling days (ANOVA). Serum CA-125 median (and 25–75 centile range) levels were 30.1 (16–64.5) U/ml in group1 vs. 21.6 (13.9–32.9) U/ml in group 2 (P<0.04). Serum progesterone levels showed a median of 86 (32.5–180) ng/ml for group 1 and 17.9 (14.4–89.8) ng/ml in group 2 (P<0.001). A CA-125 level of 40 U/ml or more was found to give a probability of ongoing pregnancy of 85.7%. A progesterone level at or above 20 ng/ml determined an 80.3% probability of ongoing pregnancy. CA-125 and progesterone showed a statistically significant positive correlation (r = 0.4; P=0.001). Cut-off levels of serum progesterone and CA-125 of 20ng/ml and 50U/ml respectively, 12 ± 1 days after ET, give a high probability of detecting women who will have a viable intrauterine pregnancy after ART cycles.